Electronic cigarettes may encourage teens to smoke regular cigarettes

A large new study finds that the two behaviors go hand-in-hand

Among the concerns expressed by critics of electronic cigarettes, or e-cigarettes, is that the devices could serve as a gateway for young people to take up cigarette smoking. Now a large study has provided evidence that they may be right—or, at the very least, that e-cigarettes aren't helping to end the youth tobacco epidemic and may actually be worsening it.

In the study, published March 6 in the journal JAMA Pediatrics, researchers looked at survey data collected from 40,000 middle- and high-school students in 2011 to 2012. The students were asked, among other things, whether they'd ever tried conventional cigarettes, whether they currently smoked, and if they'd ever used or were currently using e-cigarettes—battery-powered devices that deliver vaporized nicotine and come in a variety of flavors, including fruit and candy flavors. (Such flavors have long been banned in traditional tobacco cigarettes.)

The researchers found that students who used e-cigarettes were more likely to have smoked conventional cigarettes in the past (defined as at least 100 cigarettes, or 5 packs, in their lifetime) and to be current smokers. In addition, among current conventional smokers, those who were also currently using e-cigarettes tended to smoke more than those who didn't use e-cigs. An earlier study of young people in Korea reached similar conclusions.

It's not possible to conclude whether using e-cigarettes actually caused teens to smoke more, or whether teens who are heavier smokers are more likely to also use e-cigarettes. But the findings are important either way because they suggest that e-cigarettes aren't effective as smoking-cessation aids, as they've been touted by some proponents, but rather are linked with higher use of regular cigarettes.